Doctor Answers 17

Effect of Smoking on Rhinoplasty

The effects of smoking on nasal surgery (or any other surgery, for that matter) are multi-factorial, and play into the common recommendations regarding tobacco use before and after surgery.

Tobacco use is a bad idea in surgical patients because it contains nicotine, which is a powerful vasoconstrictor, cutting off blood to the tissues which are traumatized during surgery and often having a horrible detrimental effect on healing and scarring and possible infection. This is true of cigarettes, cigars, chewing tobacco, nicotine gum, or electronic cigarettes that contain nicotine.

In the case of cigarettes or cigars in particular, this negative impact on healing is compounded by the increased exposure to carbon monoxide which results from the actual combustion of the tobacco. While the nicotine affects blood flow, carbon monoxide affects the blood's ability to carry oxygen, thereby decreasing oxygen delivery to the healing tissue that needs it so much.

Specifically regarding your concerns regarding making your nose crooked again or causing movement, it's possible that the delay in healing that occurs as a result of smoking can decrease the stability and strength of your nose at this stage - typically by 17 days, the bones are "stuck" in place, but in a smoker, the delay at this time can leave you more vulnerable to trauma and resulting unintentional repositioning of the bones.

Bottom line - anything that affects healing or the risk of infection will increase the risk that you'll get unwanted results and increase the likelihood that you'll need more surgery down the road - a prospect which is neither pleasant nor easy.

Smoking and results of rhinoplasty

March 30th, 2010

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Smoking itself will probably not directly cause any movement in the structure of your nose, effecting the results of your rhinoplasty. However, smoking always effects the healing process which could indirectly effect your results. For example, it could cause one side to heal with more scar tissue or could effect the soft tissues which could change the results.

If you've gone 17 days without smoking, why not just hold off a little bit longer to avoid the risk of complications.

Rhinoplasty Pictures

Delayed healing in smokers

March 26th, 2010

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I agree with the rest of the panel that smoking is detrimental in the immediate post op period, especially in patients who have had an open rhinoplasty. The problem after the fact is it may delay resolution of swelling so I would lay off the cigarettes as long as you can and quit if possible.

Smoking and cosmetic surgery

March 25th, 2010

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Smoking prior to and immediately after cosmetic surgery of any kind is unwise. Cigarette smoke causes blood vessels to constrict, blood to flow more slowly, impairs the body's ability to fight infection and limits oxygen delivery to the healing tissues because of the carbon monoxide in cigarette smoke. This alone should be enough to make you stop smoking for good!

Smoking has obvious cancer causing risks as well as significantly accelerates the skin's aging rate. Remember, you did this to not only look better, but also to be around to enjoy the results. This is a great opportunity to quit, your body will thank you and so will your family!

Smoking after rhinoplasty

July 3rd, 2015

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Smoking is never a good idea and has innumerable detrimental effects to your health including cardiac, pulmonary, neoplastic, etc. It also impairs wound healing and may increase risk of infection in the post-operative period. Having said that, it will not change the shape of your nose after rhinoplasty. In some instances, it can lead to skin necrosis if there is an area that is poorly vascularized. This is usually not a concern for primary rhinoplasty, but could be if someone has had several revisions.

Yes

October 23rd, 2014

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It's extremely important that patients avoid the use of tobacco before and after surgery since this substance inhibits the recovery process. You should not smoke in the three weeks leading up to the nose job operation and for another three weeks afterward. This is primarily due to inhibiting blood circulation and making it more difficult to fight infection.

Smoking after rhinoplasty

October 9th, 2014

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Healing wounds after surgery are negativly affected by smoking because the nicotine cuts off the blood supply to the wound. Therfore bad scarring and potential infections can result. Don't smoke after surgery.

Smoking and surgery

August 2nd, 2014

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Here are the major points of smoking Tobacco or Marijuana before or after surgery:1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. This is especially bad in breast reductions or face lifts. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk. Your skin and tissue can turn black and fall off if this happens. In fat transfer, the constricted blood flow can cause the fat to not get a blood supply and die. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke. Hookah also does not decrease nicotine.2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.Best wishes,Pablo Prichard, MD

Avoid Smoking in the Pre and PostOp Periods

We
generally recommend that cosmetic surgery patients not smoke in the pre and
post-operative periods. Although cigarette smoking won’t cause structural
changes, it can adversely impact wound healing.

Cigarette
smoking can decrease blood supply and oxygen delivery. This can adversely
impact wound healing and can increase scarring. Cigarette smoking can also
negatively impact pulmonary function. For these reasons, cigarette smoking
should be avoided in the pre-operative period.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.